Get Aetna Editable Fsa Form

This guide provides a clear and user-friendly approach to completing the Aetna Editable Fsa Form online. By following the steps outlined below, users can accurately fill out their reimbursement request while ensuring all necessary information is included.

Follow the steps to accurately complete your reimbursement request.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section of the form, enter the company name, ensuring it is spelled correctly as this is crucial for the reimbursement process.
3. Proceed to input your name in the employee name field; this must match your official documents to avoid processing delays.
4. For flexible spending account claims, fill in the date of service using the format MM/DD/YYYY, followed by the name of the provider and a contact number for them. Include the Social Security Number (SSN) if required.
5. In the description of service field, provide a brief but clear summary of the service received. Subsequently, note down the claim amount corresponding to each service rendered.
6. If applicable, enter details in the child/dependent care claims section. Input the date of service, provider's name, and their tax identification number followed by the description of services and claim amounts.
7. Sum up the total of all claim amounts and enter this in the designated total field.
8. Review and check your entries for accuracy, then sign and date the employee certification section, affirming that all claims are valid and have not been previously reimbursed.
9. Compile your copies of acceptable proof of expenses and attach them to the form. Ensure you retain the original documents for your records.
10. Finally, submit your completed form by faxing it to the specified number or mailing it to the address provided.

Complete your Aetna Editable Fsa Form online today and ensure a timely reimbursement process.